Community health programs save lives and create livelihoods. However, scaling and sustaining high-quality programs to meet the growing demand for services faces a systemic barrier: financing. In Africa alone, there is an estimated $4.4 billion annual funding gap for community health. Further, the majority of existing funding in the region is directed towards vertical, disease-specific community health worker programs, despite strong evidence for the efficacy and cost-effectiveness of integrated programs, in which health workers are trained across a comprehensive primary health service package.
To meet the promise of professionalized community health workers—and unlock corresponding benefits for universal health coverage, pandemic preparedness and response, and gender equity—we must radically transform community health financing. This is why Last Mile Health’s strategic plan focuses on influencing the availability, durability, and effective deployment of funding for community health. A key driver is our leadership role in Africa Frontline First, alongside the Financing Alliance for Health and Community Health Impact Coalition. The initiative aims to increase the number of professionalized and integrated community health workers by 200,000 in 10 countries by 2030.
A community clinic in Liberia, a Project BIRCH country.
Africa Frontline First does this through designing and mobilizing financing, including the Africa Frontline First Catalytic Fund, developed with the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund). We also work to ensure funding makes a meaningful impact for countries, which is why Last Mile Health is proud to serve as the lead service provider for the project Building Integrated Readiness for Community Health (Project BIRCH).
About the Global Fund’s technical assistance Project BIRCH
Project BIRCH is a targeted funding stream from the Global Fund that is supporting eleven countries in Sub-Saharan Africa to access expanding financing for their community health priorities. Financial support for Project BIRCH comes from a reinvestment of COVID-19 funds, which the Global Fund’s Board of Directors decided to leverage to provide technical assistance for strengthening health systems and boosting pandemic preparedness capabilities.
BIRCH is a $7 million USD funding stream that works across three areas:
- Technical assistance for strengthening community health worker programming (including quality of Global Fund’s funding requests) and building capacity of community-led and community-based organizations
- Community health system strengthening activities
- Support to regional institutions for coordination, shared learning, and advocacy
In addition, the Global Fund’s investment will help countries prepare to make the most of grant allocations within the 2023–2025 funding cycle for their community health plans. The eleven countries include Burkina Faso, Côte d’Ivoire, Ethiopia, Guinea, Liberia, Malawi, Mali, Mozambique, Senegal, Sierra Leone, and Zambia.
The Global Fund has contracted Last Mile Health to lead the delivery of Project BIRCH, which includes championing the leadership of eleven Ministries of Health that have identified priority interventions aligned to their national community health plans. In each country, we partner with in-country implementing partners who have deep experience both in community health and in the country context—partners including Integrate Health, Living Goods, and Muso Health. Last Mile Health is also working at the country level in Liberia, Ethiopia, and Malawi, where we are the direct implementer of the project, strengthening our longstanding work with these governments. We also work regionally with lead institutions the Africa CDC in providing technical guidance, joint advocacy, and convening for learning.
A community health worker keeps records at his health post.
Impact to date
Since the launch of this project at the beginning of 2023, the Global Fund, Last Mile Health through Africa Frontline First, and partners have made the following progress:
- Launched in 11 countries, with Ministries of Health identifying community health priorities to be executed with technical assistance from implementing partners
- Delivered technical assistance to all countries to accompany the Ministry of Health teams on Global Fund application processes, which resulted in all 11 countries submitting funding requests that prioritize community health
- Supported countries to secure investments for community health from unspent COVID-19 funding from the Global Fund through technical assistance
- Developed technical guidance on community health systems investments
- Planned targeted investments in systems strengthening in six countries, with common priorities including developing a community health worker master list and strengthening supervision
- Supported the Third International Community Health Workers Symposium in Liberia, which culminated in the publication of the Monrovia Call to Action by the Liberia Ministry of Health
In 2023, we also plan to work with the Africa CDC, which is leading the development of regional technical guidance for community health and convening countries to share and learn with each other.
A mother and child leaving Holeta Health Post in Ethiopia, a Project BIRCH country.
Preparations for the Africa Frontline First Catalytic Fund
Looking forward, one of Project BIRCH’s key objectives is to ensure eligible countries are able to access financing from the Africa Frontline First Catalytic Fund, hosted by the Global Fund, which will start its three-year implementation period in January 2024. Launched in September 2022 with contributions from the Skoll Foundation and Johnson & Johnson Foundation, the Africa Frontline First Catalytic Fund mobilizes nearly $100 million for professionalized community health workers—the largest fund in history for this workforce.
The technical assistance provided during Project BIRCH has identified that eight countries are eligible for subsequent funds, which were prioritized due to the high potential to accelerate their community health programs. Project BIRCH will set a foundation for these countries to receive funding, which will be disbursed starting in January 2024.
Looking forward
The COVID-19 pandemic underscored that the best emergency response is a strong primary health system powered by professionalized community health workers. Project BIRCH is expanding access to financing and setting the stage to bring in additional resources via the Africa Frontline First Catalytic Fund so countries can strengthen community health programs with the goal of enhancing countries’ response to COVID-19, boosting pandemic preparedness capacity, and accelerating impact.
Doreen Namagetsi Ali of the Malawi Ministry of Health meets with Last Mile Health staff.
For countries receiving support from Project BIRCH, the change is already tangible—and health leaders recognize the impact greater financial resources and technical guidance will have at the community level. “We hope to see improved and increased resource allocation towards community health, better coordination of community health service delivery with other program areas that will foster integration, and ultimately, increased access to health service delivery at the community level,” says Doreen Namagetsi Ali, who works in the Malawi Ministry of Health as Deputy Director Preventive Health Services – Community Health. “BIRCH funding support has been catalytic and has assisted in unlocking resources that are challenging to get in addressing community health challenges.”
